Assessment of the efferent auditory system in children with suspected auditory processing disorder: the Middle ear muscle reflex and contralateral inhibition of OAEs

Brainstem auditory physiology in children with listening difficulties. Hear Res 2023;429:108705. [PMID: 36709582 PMCID: PMC10152893 DOI: 10.1016/j.heares.2023.108705]

Children who have listening difficulties (LiD) despite having normal audiometry are often diagnosed as having an auditory processing disorder. A lack of evidence regarding involvement of specific auditory mechanisms has limited development of effective treatments for these children. Here, we examined electrophysiologic evidence for brainstem pathway mechanisms in children with and without defined LiD. We undertook a prospective controlled study of 132 children aged 6-14 years with normal pure tone audiometry, grouped into LiD (n = 63) or Typically Developing (TD; n = 69) based on scores on the Evaluation of Children's Listening and Processing Skills (ECLiPS), a validated caregiver report. The groups were matched on age at test, sex, race, and ethnicity. Neither group had diagnoses of major neurologic disorder, intellectual disability, or brain injuries. Both groups received a test battery including a measure of receptive speech perception against distractor speech, Listening in Spatialized Noise - Sentences (LiSN-S), along with multiple neurophysiologic measures that tap afferent and efferent auditory subcortical pathways. Group analysis showed that participants with LiD performed significantly poorer on all subtests of the LiSN-S. The LiD group had significantly greater wideband middle ear muscle reflex (MEMR) growth functions in the left ear, and shorter Wave III and Wave V latencies in auditory brainstem responses (ABR). Across individual participants, shorter latency ABR Wave V correlated significantly with poorer parent report of LiD (ECLiPS composite). Greater MEMR growth functions also correlated with poorer ECLiPS scores and reduced LiSN-S talker advantage. The LiD and TD groups had equivalent summating potentials, compound action potentials, envelope-following responses, and binaurally activated medial olivocochlear reflexes. In conclusion, there was no evidence for auditory synaptopathy for LiD. Evidence for brainstem differences in the LiD group was interpreted as increased central gain, with shorter ABR Wave III and V latencies and steeper MEMR growth curves. These differences were related to poorer parent report and speech perception in competing speech ability.

Audiology Clinical Practice Patterns in Acoustic Reflex Testing

Purpose:

Periodic reports of audiology clinical practice patterns, including acoustic reflex threshold (ART) protocols, provide insights into trends and assist in clinical decision making. Therefore, the purpose of this study was to examine audiologists' ART protocols, factors influencing audiologists' decision to test, and considerations for mentoring Doctor of Audiology (AuD) students in ART testing.

Method:

This study used a paper survey distributed by mail to a random sample of audiologists. Participants were 102 audiologists, representing diversity across age, clinical experience, and work setting. The survey asked participants to provide (a) demographics, (b) ART protocols, (c) rationale for ART testing, and (d) perspectives on mentoring of ART testing.

Results:

When ART testing is conducted, 100% of respondents conduct ipsilateral ART testing, compared to 75% for contralateral testing. Most use 500-, 1000-, and 2000-Hz stimulus frequencies, and 56% report 4000 Hz. Patient-related factors are the primary reason participants cite for conducting, or not conducting, ART tests. Most supervisor-participants encourage AuD students to conduct ART tests, based on patient-centered and student learning–centered reasons, and use a variety of strategies to guide students when ART findings are unusual.

Conclusions:

Fewer than half (43%) of participants conduct ART testing for all new patients, suggesting it is ancillary to the standard test battery for most participants. When ART testing is conducted, ipsilateral testing only or a combination of ipsilateral and contralateral testing is used. Ongoing trends in ART testing include continued popularity of 500–2000 Hz and ipsilateral-only or ipsilateral plus contralateral testing.

Supplemental Material:

https://doi.org/10.23641/asha.21513987

Assessment of cochlear electrophysiology in typically developing children and children with auditory processing disorder

OBJECTIVE

Children with auditory processing disorder (APD) are reported to have abnormal auditory brainstem responses (ABR) but little is understood about their cochlear integrity. Poor cochlear integrity can affect neural responses. In this study, cochlear and auditory brainstem integrity was investigated in children with APD.

METHOD

Twenty children with APD, sixteen typically developing children and twenty adults participated in this study. Click evoked electrocochleography (ECochG) and ABRs were recorded from all the participants. Cochlear responses were analyzed using a) latency and amplitude of summating potential; action potential, b) transmission time between summating potential and action potential, c) summating potential/action potential amplitude ratio and d) action potential latency difference to condensation and rarefaction polarity. Amplitude in the ABR components was examined.

RESULTS

Children with APD showed similar cochlear function to the typically developing children. There were no significant differences in wave I amplitude between children with APD and typically developing children. However, wave V amplitude was significantly reduced in children with APD compared to typically developing children.

CONCLUSION

In the absence of any functional differences in the cochlea, children with APD can show poor amplitude in the later components of the ABR. The ABR anomalies observed in children with APD arise due to poor neural processing, possibly after the first auditory synapse.

Short-Term Test-Retest Reliability of Contralateral Suppression of Click-Evoked Otoacoustic Emissions in Normal-Hearing Subjects

Purpose The objective of the current study was to investigate the short-term test-retest reliability of contralateral suppression (CS) of click-evoked otoacoustic emissions (CEOAEs) using commercially available otoacoustic emission equipment. Method Twenty-three young normal-hearing subjects were tested. An otoscopic evaluation, admittance measures, pure-tone audiometry, measurements of CEOAEs without and with contralateral acoustic stimulation (CAS) to determine CS were performed at baseline (n = 23), an immediate retest without and with refitting of the probe (only CS of CEOAEs; n = 11), and a retest after 1 week (n = 23) were performed. Test-retest reliability parameters were determined on CEOAE response amplitudes without and with CAS, and on raw and normalized CS indices between baseline and the other test moments. Results Repeated-measures analysis of variance indicated no random or systematic changes in CEOAE response amplitudes without and with CAS, and in raw and normalized CS indices between the test moments. Moderate-to-high intraclass correlation coefficients with mostly high significant between-subjects variability between baseline and each consecutive test moment were found for CEOAE response amplitude without and with CAS, and for the raw and normalized CS indices. Other reliability parameters deteriorated between CEOAE response amplitudes with CAS as compared to without CAS, between baseline and retest with probe refitting, and after 1 week, as well as for frequency-specific raw and normalized CS indices as compared to global CS indices. Conclusions There was considerable variability in raw and normalized CS indices as measured using CEOAEs with CAS using commercially available otoacoustic emission equipment. More research is needed to optimize the measurement of CS of CEOAEs and to reduce influencing factors, as well as to make generalization of test-retest reliability data possible.

Olivocochlear efferent effects on perception and behavior

The role of the mammalian auditory olivocochlear efferent system in hearing has long been the subject of debate. Its ability to protect against damaging noise exposure is clear, but whether or not this is the primary function of a system that evolved in the absence of industrial noise remains controversial. Here we review the behavioral consequences of olivocochlear activation and diminished olivocochlear function. Attempts to demonstrate a role for hearing in noise have yielded conflicting results in both animal and human studies. A role in selective attention to sounds in the presence of distractors, or attention to visual stimuli in the presence of competing auditory stimuli, has been established in animal models, but again behavioral studies in humans remain equivocal. Auditory processing deficits occur in models of congenital olivocochlear dysfunction, but these deficits likely reflect abnormal central auditory development rather than direct effects of olivocochlear feedback. Additional proposed roles in age-related hearing loss, tinnitus, hyperacusis, and binaural or spatial hearing, are intriguing, but require additional study. These behavioral studies almost exclusively focus on medial olivocochlear effects, and many relied on lesioning techniques that can have unspecific effects. The consequences of lateral olivocochlear and of corticofugal pathway activation for perception remain unknown. As new tools for targeted manipulation of olivocochlear neurons emerge, there is potential for a transformation of our understanding of the role of the olivocochlear system in behavior across species.

Reliability of contralateral suppression of otoacoustic emissions in children

OBJECTIVE

The purpose of the study was to determine the reliability in children of the medial olivocochlear reflex when measured as decibels of suppression of transiently evoked otoacoustic emissions (TEOAEs) by contralateral acoustic stimulation (CAS).

DESIGN

TEOAEs with and without CAS (white noise) were measured. In each subject, measurements were performed twice. Of particular interest was the suppression of TEOAEs by CAS and its reliability. Reliability was evaluated by calculating the standard error of measurement (SEM) and minimum detectable change (MDC).

STUDY SAMPLE

Fifty-one normally hearing girls aged 3-6 years.

RESULTS

The average global TEOAE suppression was around 0.6 dB. The highest reliability was for global values, with SEM of 0.2 dB and MDC of ±0.55 dB for the standard 2.5-20 ms recording window and slightly higher values for an 8-18 ms window. The worst reliability in the studied group was for the 1 kHz half-octave frequency band. Additionally, ears without spontaneous otoacoustic emissions had higher suppression levels than those with, but they also had lower signal-to-noise ratios, which may limit their clinical utility.

CONCLUSIONS

The current study shows that, under the studied paradigm, TEOAE suppression does not have satisfactory reliability since MDC was similar to the level of suppression.

Contralateral suppression of otoacoustic emissions in pre-school children

BACKGROUND

Contralateral suppression of otoacoustic emissions (OAEs) may serve as an index of the medial olivocochlear (MOC) reflex. To date, this index has been studied in various populations but never in pre-school children. The purpose of this study was to fill this gap and describe how the MOC reflex affects the properties of transiently evoked OAEs (TEOAEs) in this age group. In addition, the influence of the presence of spontaneous OAEs (SOAEs) in the studied ear on the suppression of TEOAEs was also investigated.

METHODS

TEOAEs with and without contralateral acoustic stimulation (CAS) by white noise were measured in 126 normally hearing pre-school children aged 3-6 years. The values of response levels, suppression by CAS, and signal-to-noise ratios (SNRs) of TEOAEs were investigated for the whole signal (global) and for half-octave frequency bands from 1 to 4 kHz. Only ears with SNR >6 dB were used in the analyses. SOAEs were acquired using the so-called synchronized SOAEs (SSOAEs) technique.

RESULTS

Ears with SSOAEs had higher response levels and SNRs than ears without SSOAEs, and suppression was lower (0.58 dB compared to 0.85 dB). Only 22% of all studied ears had an SNR >20 dB, a level recommended in some studies for measuring suppression. There were no significant effects of age or gender on TEOAE suppression.

CONCLUSIONS

Suppression levels for pre-school children did not differ appreciably from those of adults measured under similar conditions in other studies. Taken together with no effect of age in the data studied here, it seems that there is no effect of age on TEOAE suppression. However, we did find that the presence of SSOAEs had an effect on TEOAE suppression, a finding which has not been reported in earlier studies on different populations. We suggest that the presence of SSOAEs might be a crucial factor related to MOC function.

Paradoxical and labile medial olivocochlear functioning as a potential marker of auditory processing disorder in a child with learning disabilities

INTRODUCTION

The medial olivocochlear system (MOCS) is composed of fibres projecting directly onto outer hair cells and plays a role in improving the signal-to-noise ratio. The MOCS can be evaluated by measuring suppression of the otoacoustic emissions evoked by contralateral acoustic stimulation. Dyslexic children present an increased probability of auditory processing disorder (APD). These children may present paradoxical MOCS dysfunction.

CASE REPORT

We report the case of a dyslexic child with APD, who was severely disabled in a noisy environment. Audiometric tests were normal, and the central auditory assessment showed labile MOCS functioning that was not only ineffective, but also potentially deleterious, possibly accounting for this child's hearing impairment in a noisy environment.

DISCUSSION

This case illustrates the importance of audiological assessment and objective investigation of MOCS function in children with a learning disability, especially with hearing difficulties in the presence of noise, in whom auditory training can be beneficial.